384: Persistent adnexal masses and pregnancy outcome

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Diabetes, Labor, Ultrasound-Imaging

measuring volumes. Virtual Organ Computer-aided AnaLysis (VOCAL) and Sonography-based Automated Volume Count (SonoAVC) are new 3-D US volume measuring techniques. VOCAL is, however, still operator dependent. SonoAVC is a new and fully automated technique for volume measurement. It has been proposed to use FUP as an added parameter to the classification of TTTS, as up to 48% of stage I show no significant FUP despite a filled bladder and 6% of stage II still produce some urine. FUP could be used to identify isolated amniotic fluid discrepancies with normal FUP of both fetuses and TTTS with increasing amniotic fluid discrepancies based on oliguria-polyuria sequence. Aim of this study was to assess the influence of laser surgery on recipient FUP by measuring FUP using VOCAL and SonoAVC before and 24 hours after procedure. STUDY DESIGN: In a prospective study, recipient bladder volumes were acquired using SonoAVC and VOCAL every two minutes during 30 minutes before and 24 hours after laser procedure. FUP was calculated using method I: (V2 – V1) ⫻ 60/ time interval and II: slope of linear regression of three or more consecutively increasing bladder volumes ⫻ 60. Paired t-test within a mixed model was used to assess FUP before and after procedure. RESULTS: 28 cases were included, containing 121 series of FUP assessment. SonoAVC FUP was 8.28 ml/hr (6.56-10.01) before and 4.92 ml/hr (3.20-6.65) after, P⫽0.01. VOCAL FUP was 7.59 ml/hr (6.079.10) before and 4.68 ml/hr (3.18-6.18) after, P⫽0.01. CONCLUSIONS: FUP decreases significantly within 24 hours after laser procedure regardless of measurement technique or method of calculation. More research should be done on FUP measured with SonoAVC as a predictive parameter in monochorionic twins.

384 Persistent adnexal masses and pregnancy outcome William Goh1, Monica Rincon2, Jorge Tolosa2, Roya Sohaey2, Leslie Arpin2, Rene Riano2, Shannel Adams1, James Davis1, Justin Bohrer1, Ivica Zalud1 1 University of Hawaii John A Burns School of Medicine, Honolulu, HI, 2Oregon Health & Science University, Portland, OR

OBJECTIVE: To determine maternal and fetal outcomes in women diagnosed with persistent adnexal masses in pregnancy. STUDY DESIGN: A retrospective cohort of pregnant women diagnosed with a persistent adnexal mass 5cm or greater between 2001 and 2009 at two university hospitals. Masses that resolved spontaneously were excluded. Data collected included gestational age at diagnosis, at delivery and at surgery (for mass removal) and number of follow up ultrasounds after diagnosis. Outcome data included miscarriage, preterm labor/birth, ovarian torsion and admission for pain or surgery. Data was analyzed for maternal antepartum and post partum complications. Neonatal outcomes were assessed for birth weight, Apgar scores and complications (IVH, RDS, death, sepsis, transfusion). RESULTS: 24,868 patients had obstetrical ultrasounds performed at our institutions. 1225 adnexal masses were identified (0.05%). A persistent adnexal mass 5 cm in diameter or greater was found in 148 (12.1%) patients. 99 charts had complete maternal/fetal data. Average gestational age at diagnosis was 17.5 weeks and the mean number of follow-up scans was 2.1. 4/99(4% )patients had a miscarriage after diagnosis and 1/99(1%) miscarried after surgery. Average gestational age at delivery was 37.6 weeks. 8/99(8%) had ovarian torsion, 10/ 99(10%) had admission for pain, and 11/99(11%) had preterm births. Average neonatal weight was 3229.8 grams and mean Apgars were 8(1 min) and 8.7(5 min). There was 1 neonatal death related to extreme prematurity(1%). 3 neonates had RDS(3%) while IVH, sepsis and need for transfusion was found in 1%. Surgical pathology was obtained in 38 patients. The most common path diagnosis was dermoids (29%). Serous and mucinous cystadenomas accounted for 24% of adnexal masses. 5 LMP tumors were removed. No overt malignancies were seen. CONCLUSIONS: The diagnosis of a persistent adnexal mass in pregnancy does not confer an increased risk of maternal or fetal adverse outcome. However, 18% of patients had torsion or pain supporting a

Poster Session II

policy of surgical intervention in the 2nd trimester for a symptomatic mass.

385 Measurements of the lower uterine segment in normal pregnancies and in pregnancies with previous cesarean section Yuval Ginsberg1, Israel Goldstein1, Udi Ergaz2, Lior Lowenstein2, Zeev Weiner1 1

Rambam Medical Center, Haifa, 2Rambam Health Care Campus, Haifa

OBJECTIVE: We aimed to establish normal values for the width of the

lower uterine segment (LUS) throughout gestation in normal pregnancies and in women with previous cesarean section and to assess the factors that may affect the width of the LUS. STUDY DESIGN: In a cross sectional study we measured the width of the LUS in all women who were referred to our ultrasound division between 11-41 weeks of gestation. LUS width was measured trans-vaginally with 5-9 MHz transducer (Voluson 730 ProGE Healthcare). Fetal weight, placental location, and cervical length were also documented. Socio demographic data was retrieved from patients electronic charts. Statistical analysis was done with a significance level of 0.05. RESULTS: 236 women with a median age of 30 (20-44) years were included in our study. The median parity was 2 (1-6) and 26% of the patients had previous cesarean section. Normal values for the LUS width were established throughout gestation. Multivariate linear regression demonstrated that gestational week was the only independent factor associated with the total width of the LUS (r⫽0.57, P⬍0.0001). For every one week of increase in gestational week there was a 2 millimeter decrease in the total width of the LUS. Only during the third trimester of pregnancy, patients who had a previous cesarean section had a significantly thinner LUS compared with those who did not have a cesarean section (64 mm⫾16 vs. 88 mm⫾25, P⫽0.002). In addition, correlation was found between the number of cesarean sections and the width of the LUS measured during third trimester of pregnancy (r⫽ ⫺0.27, p⬍0.02). CONCLUSIONS: Gestational week and a history of a previous cesarean section correlate with the LUS width. The normal values of the LUS width should be used to assess the risk for uterine rupture.

386 The nuchal translucency examnination leading to early diagnosis of structural fetal anomalies Israel Goldstein1, Boris Weizman1, Ron Beloosesky1, Khatib Nizar1, Israel Thaler1, Zeev Weiner1 1

Rambam Medical Center, Haifa

OBJECTIVE: To evaluate the ability to diagnose structural fetal anom-

alies during or soon after an extended nuchal translucency (NT) examination. STUDY DESIGN: The study included all women who had a routine NT examination and women who were referred following an abnormal NT examination. The sonographers were instructed to pay attention to fetal anomalies while performing the NT examination. Each examination was initially attempted transabdominally. Failure to obtain adequate views transabdominally was an indication for a transvaginal examination. When a structural fetal anomaly was detected or suspected, a full fetal anomaly scan was performed. When diagnosis could not be established, fetal anatomy scan was repeated after 14 weeks’ gestation. Fetal cardiac scanning was performed transvaginally, immediately or within 3 days after an increased NT was observed. When fetal anomalies were diagnosed the patients were informed about the possibilities of terminating the pregnancy or continuing the work-up and follow-up. RESULTS: We performed 4467 NT examinations during the study period and additional 123 fetal cardiac scanning following an abnormal NT examination. Overall, we performed 365 fetal cardiac scanning between 11-14 weeks’ gestation. The fetal anomalies detected included the following: three skeletal anomalies, seven brain anomalies,

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